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Home My WebLink About020-1001-20-010 (2)St. Croix County Planning andZoning F,;,,o,.,,,,,,.zz.10„a,3:<o:=6PAI Pace I of I Detail Sanitary information Computer #: 020-1001-20-010 SublPlat: metes & bounds Section: 7 Parcel #: 07.29.19.2B10 Lot: 1 TNIRNG: T29N R19W Municipality: Hudson, Town of CSM: Vol. 22 Pg. 5440 114 1f4: SE 114 NB 114 Owner: Storer, John 1076 Trout Brook Road Hudson, Wl 54016 State Permit: 69675 Issued: 09/2511985 POWTS Dispersal: Non -Pressurized In -ground Permit: New County Permit: 0 Installed: 11/15/1985 POWTS Detail: Bed- Seepage Bedrooms. 4 WI Fund: POWTS Pretreatment: NA [dotes Issuer/Inspector As Built Plumber Other Re uirernents Harold Barber Yes Hopkins, Richard Harold Barber Signed Off: Yes Additional Notes Mone Owed file this permit with the replacement 5 years later. $0.00 There was a mistake on deed that said this was in sec. 7 of St. Joseph, so that's where the replacement permit was filed. Listed as lot 3 of Trout Brook Hills, an unrecorded plat Owner: Storer, John 1076 Trout Brook Road Hudson, Wl 54016 State Permit: 180306 Issued: 10/22/1992 POWTS Dispersal: Non -Pressurized In -ground Permit: Replacement County Permit: 0 Installed: 10/23/1992 POWTS Detail: Trench - Seepage Bedrooms. 3 WI Fund: POWTS Pretreatment: NA Notes Issuer/Inspector As Built Tom Nelson Yes Mary Jenkins Signed Off: Yes Maintenance Scheduled Pump Date Pumped 10/23/1995 9i112005 91112008 10/21/2008 10/21 /2011 5/1/2011 5/1/2014 F Plumber Other Requirements Additional Notes MqRej Owed Ulbricht, Robert This is a metes & bounds parcel <1 acre known as 50.00 Parcel #3 in deed- Permit entered In Hudson, but original permit mistakenly entered in St. Joseph 030-1028-50-000 at time of installation. Moved file in archives to Hudson. See 1985 original permit Bob's certification of tank shows existing system only 5 years old - check 1986/87 archives for original and file with replacement permit. Notification Notification 04/20/2006 [Pi Parcel ##: 020-1001-20-010 s 07/22/2011 03-34 PM PAGE 1 OF I Alt. Parcel #: 07.29.19.2B-10 Current X 020 - TOWN OF HUDSON ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 01 /15/2008 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner MARTIN E & SUSAN A RICHARDS O - RICHARDS, MARTIN E & SUSAN A 1076 TROUT BROOK RD HUDSON WI 54016 Districts: SC = School SP = Special Property Addresses): * = Primary Type Dist # Description 1076 TROUT BROOK RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.650 Plat: 5440-CSM 22-5440 030 & 020-2007 SEC 7 T29N R19W PT NE NE & SE NE (TN OF Block/Condo Bldg: LOT 01 HUDSON & ST JOSEPH) BEING PT GSM 22-5440 LOT 1 OTHER PT OF CSM 1N ST JOSEPH 030-1028-90-025 (107H-10) Tracts): (Sec-Twn-Rng 40 114 160 114) 07-29N-19W NE NE 07-29N-19W SE NE Notes: Parcel History: Date Doc # Vol/Page Type 08/23/2007 858528 22/5440 CSM 06/27/2007 854563 WD 07/23/1997 889/378 07/23/1997 840/587 mnrs. 2011 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/16/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.650 79,600 250,900 330,500 NO Totals for 2011: General Property 2.650 79,600 250,900 330,500 Woodland 0.000 0 0 Totals for 2010: General Property 2.650 79,600 2501900 330,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Da te: Batch #: Specials: User Special Code Category Am ount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 14 RECEIVED Ilt It. mix clou" VJRVUOR'S RECOM CERTIFIED SURVEY MAP LOCATED IN THE NE Y40F THE NEY4AND THE SEY4 OF THE NEY40F SECTION 7, T29N, R19W, TOWNS OF HUDSON AND ST. JOSEPH, ST. CROIX COUNTY, WISCONSIN. OMMAERS.- MARTIN & SUSAN RK>VV:?JM 1076 TROUT BROOK ROAD LEGEND HUDSON. W1 - 54016 4;0� - INDICATES SECTION CORNIER (AS NOTED) CS - INDICATES 1.3' (CKff SIDE DIAMETER) IRON PIPE FOUND, C) INDICATES 1' X 240 IRON PIPE WEIGHING 1.68 LBS PER LINEAR FOOT SET. (R) INDICATES PREVIOUSLY RECORDED IWORMIAT)ON, AOOTE.- No NEW LOTS HAVE BEEN CREATED. THE PURPOSE OF THIS MAP IS TO OOMBNAE THAT PARCEL PREVIOUSLY OWNED BY THE RICHARDS AS DESCRIBED ON DOCUMENT NO. 819995 WITH THEIR MOST RECENT ACQUISITION OF THAT PARCEL DESCRff3ED ON DOCUMENT No. 854563. THE NET RESULT IS ONE LOT AS SHOWN 4-ERFON. TOWN. COUNTY AND STATE APPROVALS ARE NOT REQUIRED TO COMBINE THESE PARCELS. ON 3W 459 m SCALE (N FEET 1w N88*563()T- 562-00' THIS PARCEL DESCRIBED IN DOCUMENT NO. 854563 LOT 1 440,081 SQUARE FEET (10.10 ACRES) pREvj0uS LOT LINE GARAGE WELL iai APROXIMATE TOWNSHIP DIVE DWELLING THIS PARCEL DESCRIBED IN DOCUMENT NO. 819995 S860-0'ZM 56Z34' R S118`55-300W 562-00') It 1D UNMAT7M) LANDS THIS INSTRU?AE NT DRAFTED BY: JOSEPH 1N. GRANBE RG 5-2295 1 - 1 of 2 SLPTib AREA 1lflll lllll'".' ;''ll IlIII IIlII �11111 Illl IIII $5852$ KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 08/23/2007 10:30AM rC7QTTGTf:f) QIP1(f:V MAD VOL: 22 PAGE: 5440 22 -- -�ZE ��40 REC FEE: 13-00 N w**a _T (2 E caNR*RESE�C-rIQN 7 1.25" IRON PIPE FOUND CHECKED WITH TIES) 25 Lu u-i 0 10 m CD UJ tn F5 LU Cn Lj- C.0 U-i Lu 0 Lu G B R 9 NE1N A HMOND U wl J < %. 4:t- "04 s u fro, x "43 0 6 PREPARED BY: GRAMSERG SURVE--r7NG, SNC. 1235 C.T.H.ffEw NEW RICHMOND, WI 54017 PHONE (715) 246-7529 JOB NO. 07-050 E3/4 CORNER, SECTION 7 (ALUMINUM CAP FOUND) SHEET I OF 2 Vol. 22 Page 5440 OG1� s2f TZ i� AS BUILT SANITARY SYSTEM REPORT OWNER TOWNSHIP SECTION T-N-R _W ADDRESS �'�� ST. CRO CO UNTY, O UN TY, WISCONSIN SUBDIVISION LOT LOT SIZE PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM 6f-C 4774C,4-Z� P/49r pC,1 4.) r Iry Tom" • Foie F0 s-�- /Sox INDICATE NORTH ARROW 70A o.*= R,b&?io,u r-j&-v7- �ie 5- BENCHMARK: Elevation and description: sCription. Alternate benchmark SEPTIC TANK:Manufacturer: �' 'Liquid Cap. p Rings used: Manhole cover elev:' Final grade elev:7 g Tank inlet elev.: Tank outlet elev.0 7/� r No. of feet from nearest road:Front , Side , Rear Ft. From nearest prop. line:Front , Side , Rear Ft. ____� No. of .feet from: Well > 000 , Building: �y (Include this ,information in the above plot plan) (2 reference dimensions to septic tank) SEE REVERSE SIDE PUMP CHAMBER Manufacturer: Liquid capacity: Pump Model: Pump/S.1i,phon Manuf act.: Pump Size Elevation of inlet: Bottom of tank elevation Pump on elev.:-.�,�"Pump off elev.: Gallons/cycle: Alarm: Man.. n.. Switch Type,----- Location Dis"hce from nearest prop. line: Front_, Side Rear Ft. Distance from: Well Building C:�) 1000 . `� X 0 SOIL ABSORPTION SYSTEM Bed: Trench: Seepage Pit: Width: Length Number of Lines:3 Area Built Exist. Grade Elev. Proposed Final Grade Elev. Fill depth to top of pipe: ' '' No. feet from nearest prop. line:Front Side Rear 0. 0 0 No. feet from well: No. feet from building 7 Ft. HOLDING TANK Manufacturer: capacity: No. of rings used: Elevation of bottom -tank: Elevation of inlet,: No. feet from nearest prop. line:Front—, Side Rear Ft. No. feet from: Fell building nearest road Alarm Manufacturer: INSPECTOR J'A DATE: "/V2. PLUMBER ON JOB: 6/90:cj LICENSE NUMBER: HOMESITE SEPTIC PLUMBING CO. $55 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRtGHT WO. MASTER PLUMBER LIC. NO . 3307 M.P.R.S. MINN. INSTALLEC"R & DESIGNER LIC. 140.00663 HOMESITE SEPTIC PLUMBING CO. 655 O-NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MPSTER PLUMBER LIC. NO.3307 M.P.R.S. MtNN. ff'fiTALLER & DESIGNER LIC. NO. 00663 Atz"o.-kA �C,3 /yoo Gars o y3 ` 7" PIP- ySr£ !/ z• 5Ft7f 3-0 zl 70' r i z All 7Af-,oV c4,5- 1vVge-Vpe•--)7-r v� - 3,6 -30 5-0 IP 7-e c r nrnmTr�u� .CT ..TC)�FUN 7 _ 7Q _ 7 9 _ 1 (1711 NF. _ NF. _ TRniTT BROOK RD t part t o � W AT mermit Holder's Name: ❑ City ❑ Village [R Town of: TORRM .1 - & THIRRES UBHASJ S . JOS EPH ev.: Insp. BM Elev.: BM Description: Z420--2, J 5a:22'7je,4C',_ 7- - ro V TANK INFORMATION dOk ? ELEVATION DA' TYPE MANUFACTURER CAPACITY Septic .� � S l / c9"0 0 Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P 1 L WELL BLDG. Vent to Air Intake ROAD Septic '7/ b Q 0 Y ZI NA D,Osi ng NA Aeration NA Holding PUMP/ SIPHON INFORMATION Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft L H Forcemai n Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM County: Sanitary Permit No.: 180306 State Plan ID No.: Parcel Tax No.: 030-1028-50-000 A A9200387 STATION BS HI FS ELEV. Benchmark 4 I o0,oq Bldg. Sewer St/Ht Inlet St 1 Ht Outlet �IC �3 ,7v IV Inlet Gtg� �3,U � Dt Bottom Header / Man. -7 - s - Q r Dist. Pipe -r�7 7 �' ni�13 4 a, . 3 Bot. System Ci j .,e C, r .S a Final Grade BED/TRENCH Width 1Len 2th No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ?� N 1 �3. 1 DIMENSIONS SETBACK . SYSTEM TO P 1 L BLDG WELL LAKE 1 STREAM LEACHING Manufacturer: INFORMATION CHAMBER Type Of �� / r Model Number: System: o� o OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia _ Length Dia. Spacing SOIL COVER x Pressure Systems only xx Mound Or At -Grade Systems only Depth Over Depth Over xx Depth Of- xx Seeded 1 Sodded xx Mulched r� Bed 1 Trench Center 0� J Bed / Trench Edges �. Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COM M E TS: {Include code discrepancies, persOD5 present, e f, VT r�3 rPn..- " ki.+m i r- J .ram+'4-�i� j '� 'c� C..� �"•.XtY ��'G.E, f F t � u � �-- -� l LOOAT I ON ; ST . JOS EPH 7.2 9.19.10 7 j HE , TROUT BROOD RD . TP T�4 ' _i T�* Plan revision required? ❑ Yes ❑ No Use other side for additional information. 149 C� ICJ SBD-6710 (R 05191) Date inspector's Signature Cert- No. SANITARY PERMIT APPLICATION DILHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY IL WWkWMWLM I 5771L EMMMA I I STATE SANITRY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than 8% x 11 inches in size. ❑C hi e it e iV 2to p Pevious application —See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. PROPERTY OWNER _,,( PROPERTY LOCATION ,v v�C�T��S"r� -Y,,v i lx., s 7 T- 2? N I R E (or) W PROPERTY OWNER'S WILING ADDRESS LOT # BLOCK # /fJ7 & 77V0 0 7— /5iP00dt" IV 4 CITY, STATE �'1. ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER 'P y9� M -�to-W 'S, -3�fo65 OR� . �,>o ,7 ( ) �L61 1111. TYPE OF BUILDING: Check one L-J CITY J�� NEAREST ROAD State Owned 13 VILLAGE: ra'"I OF: ❑ Public LLJ 1 or 2 Fam. Dwelling—# of bedrooms PARCEL TAX NUMBER(r) 111111. BUILDING USE: (If building type is public, check all that apply) :J 3 �% " � (��J � �� 1 El Apt/Condo 2 ❑Assembly Hall 6 ❑Medical Facility/Nursing Home lo ❑Outdoor Recreational Facility 3 ❑Campground 7 ❑Merchandise: Sales/Repairs 11 El Restaurant/Bar/Dining 4 ❑Church/School 8 ❑Mobile Home Park 12 ❑Service Station/Car Wash 5 ❑ Hotel/Motel 9❑Office/Factory 13 ❑Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. El New 2. R] Replacement 3. El Replacement of 4.0 Reconnection of System System Tank Only Existing System 13) ❑ A Sanitary Permit was previously issued. Permit V. TYPE OF SYSTEM: (Check only one) -- Date Issued 5.0 Repair of an Existing System Non -Pressurized Distribution Pressurized Distribution Experimental Other 11 1:1 Seepage Bed 21 0 Mound 30 1:1 Specify Type 41 El Holding Tank 12 F1 Seepage Trench 22 El In -Ground 42 0 Pit Privy 13 El Seepage Pit 2w Pressure 43 0 Vault Privy 14 El System -In -Fill —3 V1. ABSORPTION ABSORPTION SYSTEM INFORMATION: 0 07 l.A 1 . GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE rV11. REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) 9/. 5* f 5E LE) V A T 10 N 300M Feet 99 75 Feet 11. TANK V Vil TANK INFORMATION CAPACITY in gallons New xisting Total Gallons # of Tanks Manufacturer's Name Prefab Concrete Site Con- Steel Fiber- glass Plastic Exper. App. Tanks Tanks I strutted Septic Tank or Holding Tank I IOU /r Lift Pump Tank/Si:phon Chamber I F-1 I F-1 1 0 1 V111111. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City, State, Zip Code): I amnlb -4. WN IX. COUNTY/DEPARTMENT USE ONLY 0 Disapproved Sanitary Permit Fee (Includes eroundwater ate 71ssued 0 Iss Agent Signa o Stamps) [KApproved 0 Owner Given initial gee) Adverse Determination J- - - - X. CONDITIONS OF APPROVAUREASONS FOR DISAPPROVAL: 4� SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. .A sanitary permit is valid for two (2) years. 2. Your. sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Fora (SBD 6399) to be submitted to the county prior to installation. 5. onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning Aur onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To. be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. IL Type of building being served. Check only one and complete ## of bedrooms if 1 or 2 Family Dwelling. Ill. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. Vl. Absorption system information. Provide all information requested in ##1-7. Via Tank information. Fill in the capacity of every new and/or existing tank, lost the total gallons, number of tanks and manufacturer's name. Indicate prefab or, site constructed and tank material. Complete for df1 septic, purnplsiphon and holding tanks for this system. Check experjmer-tai approval or if tanks received experimental product approval from DILHR. Vill. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. I X. Co my/Department Use only. X. County/Department Use only. Complete plans and specifications not smaller than 8'/ x 11 inches must be submitted to the county. The plans must include the following; A) plot plan, drawn to scale or with complete dimensions, location of holding tanks), septic tank(s) br other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the pormit issuance. Should this development be intended for resale by ownerjcontractor,(spec mouse), then,a second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. Owner of o pr petty Location of -property '1/4 4 Section i �� -- /� / , , T N RW r Township T �O� '&:�7 /74— Mai 1 ing address 7�r' Z��`-Z3 Af 0 06- Address of site Subdivision name- �' , �- `�26 -7 Jk o. Lot n Other homes on property? yes X No Previous owner of oronerty 'L ` Total size of parcel Date parcel -was created Are all corners and lot lines identifiable? x - .-Yes No Is this property being developed for (spec house)?, Yes X No *� e Volume and Pa �` ge Number/ as recorded with the Re ister of Deeds. g INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & THE SEAT, OF THE REGISTER OF DEEDS. In addition a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of County Register of deeds as Document No. 1 ✓2��r l 0 \ >r�� , Signature of -hp�licant Date of Signature Cb-applicant Date of Signature S T C - 105 •� �/ _ �l'� % SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County 1-0.10 -f 76A,�:s � ,_)"Iol OWNER/BUYER ��.._ 0.7" 13o/0ADDRESS /7)�V7- 49,& FIRE NUMBER '-7 CITY/STATE -.0L/ ZIP -7 PROPERTY LOCATION: 11141-VAC 1/4, SECTION TO-4'N 'R. aw -up-now TOWN OF 56 J /741� St. Croix County, e 5-401 _ 1/ 3Lop SUBDIVISION a, 04 2) — I LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed septic tank pumper. What you put into the system can of f ect the function of the septic tank as a treatment stage in the waste disposal system, ! St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978* St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St, Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after 'inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zonipg Officer within 30 days of the three year expiration dat SIGNED:.m 1( DATE: St, Croix co. Zoning Office 911 4th St, Hudson, WI 54016 ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the residence located at: 1 4 1/41 Sec . T.. )"'?-N R I—W Town 0 f Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. -Ar Last time serviced Did f low back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length of timegallons minutes Capacity: Construction: Prefab Concrete Steel Manuf acurer if known) e5e-4" Age of Tank (if known): yjtj:-F'-jX'54 (Signature) Other G-W— IV (Name) Please Print (Title) (License Number) (Date) Form to be Completed by licensed plumber (s.145.06, Wisconsin S"tatutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). a � Name Signature M+�,-/ M P R S 3 3 5/88 YIP-781 IM, I Oupartment of Inclustry, IT I- SOIL AND SITE EVALUATION REPOI` abor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION PROPERTY OWNER: ,JA C, k- -5 PROPERTY OWNER':S MAILING ADDRESS /C? 76:7 -M,�7 v T. B /f 00-0e CITY, STATE ZIP CODE PHONE NUMBER yvpsev-vj, 4-.)1-50*, - 40 (-71s ) 3 e� - yro Page L of 3 COUNTY PARCEL I.D. # REVIEWED BY DATE PROPERTY LOCATION GOVT. LOT IfIC 114 _ 1/4,S T 2q N,R E (040 LOT # BLOCK# SURD. NAME ORCSM# OCITY []VILLAGE (TOWN INEAREST ROAD f5r. J05_4�/o 7-eauT Igie0Gam` 44 New Construction Use Residential / Number of bedrooms 171 Addition to existing building Replacement Public or commercial describe- Recommended desibed, gpd ift2 trench, gpd/ft2 Code derived daily flow gpd gn loading rate j Absorption area required bed, ft2 ltze20 trench, ft2 Maximum design loading rate , _ _bed, gpd/ft2 -:5 trench, gpd/ft2 ,.- > Recommended infiltration surface elevation(s) ,D-ft (as referred to site plan benchmark) A�xpl� L) e, Additional design / site cons* rations Parent material .5C5 n� 4A4 -Flood plain elevation, if applicable ft S = Suitable for system CONVENTIONAL MOUND IN -GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system El S 0 U (0 s El u 4S EIU Q S EIU EIS WU [Is E] U 06 at � Ground elev. 1 3ft. � " Depth to limiting factor Boring # ........ . .......... .................. Ground elev ft. SOIL DESCRIPTION REPORT Remarks:�i Zoe G CON�fiiiUS ��75 d� .S� . Cho�'sT z2 -IL /r .2 If 1 5 2- 0 CIO, i� 2- 3� -� 7s yk y/G s/ /,-f ji 4t �,f,� s � f � s IOVR 31�1 -7610Y,4 0 e Depth to limiting factor Remarks* Tir' 11AA-Mr. I WWE64F 66P -7 CST Name: —Please Prints O'NEIL RD., HUD W I E 4 0 16 1 Phone: '3 ?6 CST I S I ST CROt,, ROB R ERT ULBFI ic'E dd SS: WIS. MASTER PLUMSER Llcvo,* 01-F, CST Number: WGTAL6�R C Date. signature: C � F PROPERTY OWNER. SOIL DESCRIPTION REPORT PARCELIA Page of P Boring # ggj Ground elev. 3 Z-3 ft. Depth to limiting Ai factor Boring # InK RN111, h Ground ij elev.ft. ZA Depth to limiting factor Boring # .xrr gl Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft Depth to limiting factor Remarks: A e4� 41; tL. "rl �%- � SBD-8330(R.05/92) HOMESITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIS. MASTER PLUMBER LIC. NO. =7 M.P.R.S. MtNN. IN -TALLER & DESIGNER LIC. NO. 0066,03 .5, LEUATfoj3 -S 731 3 133 �} is T- T PcAj Z' 4F- 3 0 AID 7-e 6--ov e ,0/ lr,5 7�ec -ooq,� i HOME -SITE SEPTIC PLUMBING CO. 655 O'NEIL RD., HUDSON, WIS. 54016 ROBERT ULBRIGHT WIG. MASTER PLUMBER LIC. NO.3307 M.P.R.S. )PNIN. I!� JALLER & DESIGNER LIC. 1,40. 00663 3 117 /0 71'0,0 = / 0 o � D I T ro �y /}oo r I � v 7CI41 S . $ S7-6 --r � d I 5 g w /0 e Lit UhTI'o-k35 73 r 132. Lo, r f3 3 5 3,6 3 M f � <�k E`S -I -T Ik'£ N Cef � tow 5 O e RO REPT131 ST. JOSEPH ST. CROIX COUNTY ZONING PAGE 1 10/22/92-08:55---REQUESTS FOR INSPECTION WORK SHEETS FOR: 10/23/92 AREA: MJ Activity: A9200387 10/23/92^Type: CONVSEPT Status: PENDING Constr.. Address: ST. JOSEPH 7.29.19.107D,NE,NE, TROUT BROOK RD. Parcel: 030-1028-50-000 Occ: Use: Description: 180306 Applicant: STORER, JOHN, & THERESA BUBNASH Phone: Owner: STORER, JOHN, & THERESA BUBNASH Phone: Contractor: ULBRECHT, BOB Phone: ----------------------------------------------- Inspection Request Information..... Requestor: ULBRICHT, ROBERT Phone: Req Time: 13:10 Comments: /f3 d Items requested to be Inspected... Action Comments Time Ex 00012 FINAL INSPECTION P �1 ---------------------------------------------- Inspection History..... Item: 00012 FINAL INSPECTION J5r,Nk'ru'mut"RLHe VCL LJLUi11 LCICLGL1l C PVLLLL UDCU Elevation of vertical reference point: Proposed slope at site: 0 SEPTIC TANK: Manufacturer:.+ Liquid Capacity: Number of rings used: Tank manhole cover elevation: !` Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front,oSide o Rear,0 feet -From nearest -property line Front, 0Side, 0Rear, feet . I Number of feet from: well building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE S T C - 1.05 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/BUYER�� ROUTE/BOX NUMBER Fire Number CITY/STATE /7 d /.S Z I P PROPERT Y LOCATION: S Ve Section 7 T �21 N, RI�I W� Town of S'0'0 St. Croix County, Subdivision fi G/r �� l d , Lot number 3 • Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con- sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper* What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec- essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Depart- ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGNED ' DATE - St. Croix County Zoning office P.O. Box 98- Hammond, WI 54015 715--796-2239 or 715-425-8363 Sign, date and return to above address. / RON P! PL'r 7• E I, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, NAME (print): TESTS WERE COMP ETED ON: Al teVeY G JONNSON 9 /2 7 85' ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (opt ional): 4o'7 '5te_0N& S"r, IAAASC�xl WI -Se.. CS-r 19 464 171'S SW GaO C5T SIGUATURE: r"� DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHP-SBD-6395 (R. 02/82) — OVER —